DEAR DR. GOTT: I am a 39-year-old male. I had a total hip replacement on my left hip in July 1998. I had almost no pain (once it healed) for more than 10 years. Now I have almost constant pain and other sensations that feel as if the prosthetic is popping out or slipping.
My problem now is that the only doctor who will agree to do my revision surgery (the one who did the original replacement) is not a provider with my insurance. I have consulted two other physicians, and they both tell me that I need to wait because the plastic ball part of the prosthetic is not worn enough to warrant having the surgery. At the same time, they tell me that they can’t say for sure what is going on until they open me up.
I have had every scan/test and blood test that I know of to check for low-level infections, but all came back negative. There is one other local surgeon I can consult with, but I feel he will concur with the other two doctors and tell me to hold off on surgery.
I am currently taking 500 milligrams of naproxen twice a day and extra-strength Tylenol along with Vicodin to try and combat the pain, but it is becoming a losing battle.
Do I just pack it in and have the original doctor perform the surgery for my hip and possibly go bankrupt? Or should I wait and suffer until one of the other doctors thinks it is time for surgery? I understand that revisions always come with risk and less chance of success than the previous surgery, but I can’t take much more and am ready to give the procedure a shot.
DEAR READER: A typical prosthetic hip can be expected to last 10 to 20 years. Factors such as weight and activity levels can have a bearing of success. People who play strenuous sports, perform heavy lifting or hard manual labor, or are overweight are not as likely to have as good of an outcome as those with moderate lifestyles and average weight.
You had your hip replacement 12 years ago, around age 27. This is a young age to have required hip replacement. You do not say what necessitated this surgery; however, at this point, it is not a concern.
Given your level and frequency of pain, I believe that your hip is simply wearing out and needs to be replaced. Your young age is another factor in this decision. You still have a lot of life left to live, and that should be quality time. You are likely a good candidate for the surgery.
I don’t believe that you should go bankrupt in the process of improving the quality of your life, so I suggest you either return to one of the orthopedists who accepts your insurance to discuss why they don’t think you are a candidate, given your age and pain level, or request a referral to the final local orthopedist for another opinion. You may also benefit from reviewing nonlocal physicians who accept your insurance, including those associated with a teaching hospital or a major medical center.
To provide related information, I am sending you copies of my Health Reports “Managing Chronic Pain” and “An Informed Approach to Surgery.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.
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